Advertisement-Induced Prescription Drug Requests Patients' Anticipated Reactions to a Physician Who Refuses

Journal of Family Practice, June, 1999 by Robert A. Bell, Michael S. Wilkes, Richard L. Kravitz

Note: Attitudes, beliefs, and behaviors were assessed on a 5-point scale where higher numbers indicate a more positive attitude. Faith in regulation was assessed on a 4-point scale where higher numbers indicate greater confidence in government regulations of DTC advertising. General health perception was assessed using a 5-item subscale of the 36-Item Short Form Health Survey. Higher numbers indicate a more positive assessment of health.

CQ denotes communication quality; SD, standard deviation; DTC, direct-to-consumer.

(*) Significant association between the reaction to request nonfulfillment and the predictor variable (P <.001).

([dagger]) Significant association between the reaction to request nonfulfillment and the predictor variable (P <.01).

([double dagger]) Significant association between the reaction to request nonfulfillment and the predictor variable (P <.05).

APPROVAL OF DTC ADVERTISING REACTIONS TO REQUEST NONFULFILLMENT

Our second hypothesis was that patients who positively evaluated DTC advertisements would exhibit greater resistance to prescription nonfulfillment than patients with a less positive viewpoint. As expected, disappointment, persuasion, prescription shopping, and doctor switching were all judged as more likely responses to physician refusal by respondents who had positive attitudes toward DTC advertisements and undue confidence in the government's regulation of DTC advertisement content.

People who had requested information or a prescription from their physicians in the past as a result of exposure to a DTC advertisement were more likely to believe that they would react with disappointment and persuasion to not having the prescription filled; past advertisement-induced drug requests were not significantly related to forecasts of prescription shopping and doctor switching.

HEALTH FACTORS AND REACTIONS TO REQUEST NONFULFILLMENT

Our third hypothesis was that stronger reactions would come from individuals who had poorer health, as indicated by their own general health perceptions and their current use of prescription drugs. This hypothesis received inconsistent support. Lower ratings of general health were associated with greater projections of disappointment and persuasion, but not with prescription shopping and doctor switching. Current use of prescription drugs was associated with higher likelihood ratings for persuasion only.

DEMOGRAPHIC CHARACTERISTICS

We also examined the relationship of age, education, sex, income, and race on respondents' forecasts of their reactions to request nonfulfillment. The only significant association was for income. For reasons not readily apparent, middle-income respondents were more likely to report that they would respond to request nonfulfillment with persuasion and prescription shopping than lower- or higher-income respondents. The percentage of respondents who felt they would resort to persuasion in the event of request denial was 16% for respondents with household incomes less than $30,000, 31% of respondents in the $30,000 to $59,999 income range, and 20% for the $60,000 or more income group (P [is less than] .05). Similar figures (19%, 31%, and 17%, respectively) were obtained for prescription shopping (P [is less than] .05).